BSC NURSING III YEAR

1. Mr. Manikandan.T,
RN., RM., M.Sc(N)., D.C.A .,(Ph.D)
Assistant Professor,
Dept. of Medical Surgical Nursing,
VMCON, Puducherry.

2. DEFINITION
• Loss of hearing either temporarily or
permanently
• Also called anacusis

3. INCIDENCE
• Hearing impairment has been reported to
occur in 3 of every 1000 births

4. CAUSES
• Impacted cerumen
• Foreign bodies
• Middle ear disorder
• Otosclerosis
• Stenosis of external ear
• Congenital
• Trauma
• Meningitis
• Prolonged exposure to loud noises
• Prenatal exposure to rubella

5. Classification
Conductive
Sensorineural
Central/functional
Mixed

6. Conductive H.L
• It occurs in the outer and middle ear and
impairs the sound being conducted from outer
to inner ear.(because of defect in ossicle)
• Means that vibration are not passing through
from outer ear to inner ear

7. Sensorineural H.L
• It is caused by impairment of inner ear or the
vestibulo cochlear nerve (C.N VIII)

8. MIXED H.L
• It is caused by combination of conductive and
sensorineural

9. Central/ functional H.L
• It is caused by problem along the pathway
from the inner ear to the auditory region of
brain

10. Presbycusis
• Deafness occurs due to ageing

11. Based on severity
• Mild (26-40 db)
• Moderate (40-55db)
• Moderately severe (56-70 db)
• Severe (71-90 db)
• Profound (90db)

12. Based on onset
• Congenital: deafness at birth
• Acquired : deafness acquired after birth

13. Unilateral vs bilateral
• Single-sided deafness (SDD), or unilateral
deafness, refers to hearing impairment in just
one ear, while bilateral deafness is hearing
impairment in both.

14. Clinical features
• Not responding when speaking others
• Straining to ear
• Difficulty to communicate
• Suspicion
• Loss of self esteem

15. Diagnosis
• H.C
• P/E
• Rinne’s test & weber’s test
• Audiometry
• Auditory brain stem response
• Tympanometry
• EOAEs(evoked otoacoustic emissions) measures
sound originated in haircells of cochlea using
microphone and transducer

16. CONTROL AND PREVENTION
• Avoid using cytotoxic drugs
• Avoid exposure to loud noises
• No buds for ear cleaning
• Protect ear from any injury
• Monitor hearing ability periodically
• Do not practice traditional way of poring hot
oil into the ear

17. Hearing aids
• Behind-the-ear (BTE) hearing aids: These consist of a
dome called an earmold and a case, with a connection
linking one to the other. The case sits behind the outer
ear, with the connection to the dome coming down the
front of the ear. The sound from the device is either
electrically or acoustically routed to the ear.
• BTE hearing aids tend to last longer than other devices,
as the electrical components are located outside the
ear, meaning that there is less moisture and earwax
damage These devices are more popular with children
who need a sturdy and easy-to-use device.

19. In-the-canal (ITC) hearing aids:
• These fill the outer part of the ear canal and
can be seen. Soft ear inserts, usually made of
silicone, are used to position the loudspeaker
inside the ear. These devices fit most patients
straight away and have better sound quality.

20. • Completely in the canal (CIC) hearing aids: These
are tiny, discreet devices but not recommended
for people with severe hearing loss.
• Bone conduction hearing aids: These assist
people with conductive hearing loss, as well as
those unable to wear conventional type hearing
aids. The vibrating part of the device is held
against the mastoid with a headband. The
vibrations go through the mastoid bone, to the
cochlea. These devices can be painful or
uncomfortable if worn for too long.

21. Tips for Hearing Aid Care
• Cleaning
 The ear mold is the only part of the hearing aid that maybe washed frequently.
 Wash ear mold daily with soap and water.
 Allow the ear mold to dry completely before it is snapped into the receiver.
 Clean the cannula with a small pipe cleaner–like device.
 Proper care of the ear device and keeping the ear canal clean and dry can prevent
complications.
• Malfunctioning
 Inadequate amplification, a whistling noise, or pain from the mold can occur when a
hearing aid is not functioning properly.
 Check for malfunctions:
 Is the switch on properly?
 Are the batteries charged and positioned correctly?
 If the hearing aid is still not working properly, notify the hearing aid dealer.
• Recognizing Complications
 Common medical complications include external otitis media and pressure ulcers in
the external auditory canal.
 Signs and symptoms of these infections include painful ear, especially when the
external ear is touched; canal
 swelling; redness; difficulty hearing; pain radiating to the jaw area; and fever.

22. Hearing Guide Dogs
• Specially trained dogs (service dogs) are available to assist
the person with a hearing loss. People who live alone are
eligible to apply for a dog trained by International Hearing
Dog
• The dog reacts to the sound of a telephone, a doorbell, an
alarm clock, a baby’s cry, a knock at the door, a smoke
alarm, or an intruder.
• The dog alerts its master by physical contact; the dog then
runs to the source of the noise.
• In public, the dog positions itself between the person with
hearing impairment and any potential hazard that the
person cannot hear, such as an oncoming vehicle or a loud,
hostile person.
• In many states, a certified hearing guide dog is legally
permitted access to public transportation, public eating
places, and stores, including food markets.

23. Cochlear implants

24. Cochlear implants
• This thin electrode is inserted into the cochlea. It
stimulates electricity through a tiny
microprocessor placed under the skin behind the
ear.
• A cochlear implant is inserted to help patients
whose hearing impairment is caused by hair cell
damage in the cochlea. The implants usually
improve speech comprehension.
• The latest cochlear implants have new technology
that helps patients enjoy music, understand
speech better even with background noise, and
use their processors while they are swimming

25. On the outside
• A microphone: This gathers sound from the
environment.
• A speech processor: This prioritizes the sounds
that matter more to the patient, such as speech.
The electrical sound signals are split into channels
and sent through a very thin wire to the
transmitter.
• A transmitter: This is a coil secured with a
magnet. It is located behind the outer ear and
transmits the processed sound signals to the
internally implanted device.

26. On the inside:
• A surgeon secures a receiver and stimulator in
the bone beneath the skin. The signals are
converted into electrical impulses and sent
through internal wires to the electrodes.
• Up to 22 electrodes are wound through the
cochlea. The impulses are sent to the nerves in
the lower passages of the cochlea and then
directly to the brain. The number of electrodes
depends on manufacturers of the implant.

27. Indication – cochlear implant
• Bilateral SNHL above 90db where heraing aid
is not helpful.
• Damage to cochlear nerve

28. Procedure – cochlear implant
• Simple moistoidectomy is done electrodes are
placed in cochlea
• It cost around 4.5-8lakhs
• The patient after the cochlear implant needs
intensive speech and auditory training for
better discrimination of speech

29. Lip reading
• Also known as speechreading, lip reading is a
method for understanding spoken language by
watching the speaker's lip, facial and tongue
movements, as well as extrapolating from the
data provided by the context and any residual
hearing the patient might have.
• People who became hearing impaired after they
learned to speak can pick up lip reading rapidly;
this is not the case for those who are born
hearing-impaired.

30. Sign language
• This is a language that uses signs made with the hands,
facial expressions, and body postures, but no sounds. It
is used mainly by those who are deaf.
• There are several different types of sign languages.
British Sign Language (BSL) is very different from
American Sign Language (ASL). For instance, BSL uses a
two-handed alphabet, whereas American sign
language uses a one-handed alphabet.